Healthcare Provider Details

I. General information

NPI: 1780809376
Provider Name (Legal Business Name): AMERICAN INDIAN PREVENTION COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 N 23RD ST
PHOENIX AZ
85006-2428
US

IV. Provider business mailing address

PO BOX 25047
PHOENIX AZ
85002-5047
US

V. Phone/Fax

Practice location:
  • Phone: 602-424-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateAZ

VIII. Authorized Official

Name: BONNY BEACH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 602-424-1600